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PA Dynamic Rendering

Telehealth Coverage for Annual Wellness Visits

Effective March 6, 2020, CMS is allowing the expansion of telehealth services to include annual wellness visits (AWVs) for Blue Advantage® patients. The Blue Advantage telehealth expansion will remain in effect for the duration of the current federal Public Health Emergency.

As the novel coronavirus (COVID-19) continues to spread nationwide, Blue Cross has also expanded coverage for telehealth services to help providers deliver certain health services without patients leaving their homes and risking exposure to illness.

Claims Information

Effective April 21, 2020, providers should perform AWVs using both audio and video technology and file appropriate codes related to these services. Telehealth AWV claims must include HCPCS code G0438 or G0439, with place of service code 02 – telehealth. Body mass index and blood pressure results for the patient will not be required for telehealth AWV claims.

We do understand that some patients may not have access to video technology. In such cases, the patient's medical record encounter documentation should note that services were rendered via audio telecommunications only due to the patient not having access to video capabilities.

We recommend that providers review the Patient Health Snapshot for a reference of chronic conditions to evaluate, document and code on the AWV claim. Additionally, if a patient is due for a colon cancer screening, a Cologuard® test could be performed at home.

Guidance for AWVs Performed via Telehealth

We are following CMS guidance regarding telehealth services including AWVs:

  • The provider should already have an established relationship with the patient in order to do a wellness visit via telehealth.
  • The patient must virtually consent to using telehealth for a wellness visit and the consent must be documented within the medical record prior to the patient using the service.

Incentive Opportunity Extended

Because of the coronavirus outbreak, we are extending the deadline for qualifying providers to earn the $40 Annual Wellness Visit incentive through the Blue Advantage Primary Care Incentive Program through the fourth quarter of 2020.

For more information about this incentive, review the following resources: